Naloxone Use in Novel Potent Opioid and Fentanyl Overdoses in Emergency Department Patients.
Naloxone Use in Novel Potent Opioid and Fentanyl Overdoses in Emergency Department Patients.
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在急诊科患者中，纳洛酮在新型有效阿片类药物和芬太尼过量中使用。
DOI：
10.1001/jamanetworkopen.2023.31264
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发表时间：
2023-08-01
影响因子：
13.8
通讯作者：
Manini, Alex F.
中科院分区：
文献类型：
--
作者：
Amaducci, Alexandra;Aldy, Kim;Campleman, Sharan L.;Li, Shao;Meyn, Alison;Abston, Stephanie;Culbreth, Rachel E.;Krotulski, Alex;Logan, Barry;Wax, Paul;Brent, Jeffrey;Manini, Alex F.
急诊室新型强效阿片类药物 (NPO) 过量暴露患者的纳洛酮需求和临床后遗症是什么？在这项包含 537 名患者的队列研究中，所有 NPO 过量服用的患者均出现阿片类药物过量症状，并接受了多剂量的纳洛酮治疗。与芬太尼过量相比，NPO过量的患者在院内服用纳洛酮的剂量较多；美托嗪过量与心脏骤停和纳洛酮总体剂量增加有关。这些发现表明，由于在临床过量情况下观察到纳洛酮给药，NPO 可能比芬太尼具有更高的效力。这项队列研究调查了美国急诊科 (ED) 成年人中纳洛酮的给药情况，与芬太尼过量相比，新型强效阿片类药物过量。合成阿片类药物，例如芬太尼类似物和硝氮类药物，是在急诊科 (ED) 非法阿片类药物过量 (OD) 患者中检测到的增长最快的阿片类药物类型之一。然而，除了小病例系列之外，新型强效阿片类药物 (NPO)（特别是硝氮酮）的 OD 临床结果尚不清楚。旨在确定与芬太尼 OD 相比，急诊科 NPO 过量患者的纳洛酮给药和临床后遗症。这是一项队列研究亚组分析，对 2020 年至 2022 年正在进行的全国 ToxIC Fentalog 队列研究中入住急诊室且 NPO 检测呈阳性的成年人进行。纳入了急诊科疑似急性阿片类药物 OD 和残留血液样本的患者，并对 NPO 检测呈阳性的患者进行了分析。如果患者的 NPO 分析物（例如溴啡、异托尼嗪、美托尼嗪和/或 N-哌啶基依托尼氮）的验证测试呈阳性，则将患者纳入本分析。对照组包括芬太尼呈阳性且毒理学分析中没有任何其他分析物的患者。患者暴露于 NPO，包括溴啡、异托尼嗪、美托尼嗪和/或 N-哌啶基依托尼嗪。主要结果是作为 OD 后常规临床护理的一部分施用的纳洛酮剂量总数和总累积纳洛酮剂量。将 NPO 阳性患者的纳洛酮需求量和临床后遗症与仅芬太尼检测呈阳性的患者进行比较。研究期间，共筛查了2298名患者，其中717名符合纳入标准，537名拥有完整的实验室检测数据，其中11名（2.0%）仅芬太尼呈阳性，9名（1.7%）NPO（溴啡肽、异托尼嗪、美托尼嗪或N-哌啶基依托尼氮）呈阳性。患者年龄范围为20至57岁（4名男性[44.4%]和5名女性[55.6%]）。与芬太尼组 (0.36 [0.92]) 相比，NPO 组在院内接受的纳洛酮推注平均 (SD) 数量 (1.33 [1.50]) 在统计学上显着更高 (P = .02)，这对应于中等较大的效应量 (Cohen d = 0.78)。美托嗪过量与心脏骤停和纳洛酮总体剂量增加有关。美托氮酮病例的平均 (SD) 数为 3.0 (0) 纳洛酮剂量，2 名美托氮酮过量患者中的 2 名 (100%) 接受了心肺复苏。在这项队列研究中，入院急诊科确诊阿片类药物过量且 NPO 检测呈阳性的患者中，与单独芬太尼检测呈阳性的患者相比，院内纳洛酮剂量较高。需要进一步研究来证实这些初步关联。
What are the naloxone requirements and clinical sequelae of emergency department patients with novel potent opioid (NPO) overdose exposures? In this cohort study of 537 patients, all patients with NPO overdose presented with opioid overdose symptoms and received multiple doses of naloxone. Compared with fentanyl overdose, patients with NPO overdose had a higher number of naloxone doses administered in-hospital; metonitazene overdose was associated with cardiac arrest and more naloxone doses overall. These findings suggest that NPOs may have a higher potency than fentanyl due to the observed naloxone administration in the clinical setting of overdose. This cohort study examines naloxone administration among US adults admitted to the emergency department (ED) with a novel potent opioid overdose compared with fentanyl overdose. Synthetic opioids, such as the fentanyl analogue and nitazene drug class, are among the fastest growing types of opioids being detected in patients in the emergency department (ED) with illicit opioid overdose (OD). However, clinical outcomes from OD of novel potent opioids (NPOs), specifically nitazenes, are unknown aside from small case series. To determine naloxone administration and clinical sequelae of patients who were in the ED with NPO overdose compared with fentanyl OD. This is a cohort study subgroup analysis of adults admitted to the ED and tested positive for NPOs among in the ongoing nationwide ToxIC Fentalog cohort study from 2020 to 2022. Patients who were in the ED with a presumed acute opioid OD and residual blood samples were included, and those testing positive for NPOs were analyzed. Patients were included in this analysis if their confirmatory testing was positive for an NPO analyte, such as brorphine, isotonitazene, metonitazene, and/or N-piperidinyl etonitazene. A comparison group included patients that were positive for fentanyl and devoid of any other analytes on toxicologic analysis. Patients were exposed to NPOs, including brorphine, isotonitazene, metonitazene and/or N-piperidinyl etonitazene. The primary outcome was the total number of naloxone doses and total cumulative naloxone dose administered as part of routine clinical care following the OD. Naloxone requirements and clinical sequelae of NPO-positive patients were compared with those testing positive for fentanyl only. During the study period, 2298 patients were screened, of whom 717 met inclusion criteria, 537 had complete laboratory testing data, with 11 (2.0%) positive for only fentanyl and 9 (1.7%) positive for NPOs (brorphine, isotonitazene, metonitazene, or N-piperidinyl etonitazene). The age range of patients was aged 20 to 57 years (4 males [44.4%] and 5 females [55.6%]). The NPO group received a statistically significantly higher mean (SD) number of naloxone boluses in-hospital (1.33 [1.50]) compared with the fentanyl group (0.36 [0.92]) (P = .02), which corresponded to a moderately large effect size (Cohen d = 0.78). Metonitazene overdose was associated with cardiac arrest and more naloxone doses overall. Metonitazene cases had a mean (SD) number of 3.0 (0) naloxone doses, and 2 of 2 patients (100%) with metonitazene overdoses were administered cardiopulmonary resuscitation. In this cohort study of patients admitted to the ED with confirmed opioid overdose testing positive for NPOs, in-hospital naloxone dosing was high compared with patients who tested positive for fentanyl alone. Further study is warranted to confirm these preliminary associations.
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